[Subjective and objective evaluation of treating schizophrenia with classic or atypical drugs]. / Subiektywna i obiektywna ocena leczenia schizofrenii lekami klasycznymi i atypowymi.

Subjective and objective evaluation of pharmacological treatment was made in 105 schizophrenic in-patients. PANSS and Calgary scale as well as Van Putten scale were used. Fifty-four percent of subjects received classic neuroleptics and 46%--new atypical drugs for an average period of 8 weeks. The severity of schizophrenic symptoms during treatment as well as subjective evaluation of first effects of the drug did not differ among subjects treated with classic or atypical drugs. Depressive symptoms decreased significantly during treatment with atypicals but not with classic drugs. Also a significant decrease of depression was found under olanzapine treatment. The severity of neuroleptic-induced side-effects did not differ in both groups. Neurological side effects were more prominent in subjects after 4 weeks of therapy with risperidone, in comparison to patients receiving olanzapine. Forty-seven per-cent of patients showed a dysphoric reaction to the first dose of medication. After treatment with atypical drugs, better subjective evaluation of pharmacotherapy correlated with less severe general and depressive schizophrenia symptoms. Patients' better evaluation of olanzapine treatment correlated with less severe schizophrenic general symptomatology. The subjective evaluation of treatment was better in patients with less severe neurological side-effects of atypical drugs (including olanzapine but not risperidone) and less severe autonomic side-effects of classic drugs. The evaluation of pharmacotherapy made by patients' family members did not correlate with subjects' opinions after distribution of the first dose of the drugs, but correlated significantly with patients' opinion after 8-weeks of treatment. The treatment received by the patients was judged better by the family members if less severe neurological side-effects were present.

[Quality of life in schizophrenic patients treated with classic and "old" atypical neuroleptics]. / Badanie jakosci zycia a efekty farmakoterapii schizofrenii lekami klasycznymi i "starymi" atypowymi.

Subjective health-related quality of life was evaluated in 100 patients from day-hospital, treated for schizophrenia with classical (perazine, perphenazine, zuclopenthixol) or "old" atypical (klozapine, sulpiride) neuroleptics. No correlation was found between the clinical improvement (PANSS scale) and the quality of life (SF-36). After the treatment the improvement of the quality of life was significantly better in female than in male patients. In women more correlations were found between clinical improvement after treatment and the of quality of life domains. The general subjective health-related quality of life after treatment with classical and "old" atypical drugs did not differ. After the treatment those patients who received classical neuroleptics reported more physical complains but better improvement in the domain "role-emotional" than the subjects treated with "old" atypical drugs. Significant clinical improvement was found in patients treated with perazine, perphenazine and zuclopenthixol but not with clozapine or sulpiride. The presence and intensity of neuroleptic side-effects did not correlate with the quality of life. In patients who had more pronounced neuroleptic side-effects less favorable improvement was found in regard to those quality of life domains which included physical status as well as the evaluation of patients' mental health.

[Family burden of schizophrenic patients with various forms of psychiatric care]. / Brzemie rodziny pacjentów ze schizofrenia objetych róznymi formami opieki psychiatrycznej.

Caregiver burden was evaluated among family members of 90 schizophrenic patients from hospital psychiatric ward, day hospital or from community psychiatry unit. Psychopathology was evaluated with the use of PANSS while family burden with the use of Tessler's scale which allowed to differentiate between objective and subjective burden regarding assistance to the subject and patient's supervision. Schizophrenic symptoms were more severe in hospitalized patients than among patients from day hospital or patients treated in the community. Family burden, both subjective and objective was more severe among family members of hospitalized patients. There was no difference in the severity of family burden among family members of patients from day-hospital or from community psychiatry unit. The severity of positive and general schizophrenic symptoms (PANSS) correlated positively with the lack of patient's acceptance by a family member as well as with the global subjective family burden and with the necessity of taking control over patient. There was a positive correlation between the severity of schizophrenic negative symptoms and subjective family burden (dimension: assistance to the patient) and the sum of objective family burden.

[Evaluation of depressive syndromes in the course of schizophrenia with the use of Calgary scale in patients from the inpatient hospital care]. / Ocena za pomoca skali Calgary zespolów depresyjnych w przebiegu schizofrenii leczonej na subrejonowym oddziale dziennym.

Among 98 schizophrenic patients consecutively admitted to day hospital during the period of one year, the presence of depressive syndrome diagnosed with the use of Calgary Depression Scale was established in 39% of patients. The intensity of depression was higher in the patients' than in the investigators' evaluation. After therapy at day hospital, which lasted 3.7 months on average, the repeated clinical evaluation showed significant decrease of all depressive symptoms as well as schizophrenia psychopathology. In 29% of patients there were no symptoms of depression at discharge from the day hospital. In 66%, the depressive symptoms which were most severe at admission, i.e. depressive mood, hopelessness and guilty ideas of reference, showed most distinct diminution after treatment.

[Evaluation of health-related quality of life in hospitalized schizophrenics]. / Badanie jakosci zycia zaleznej od stanu zdrowia chorych leczonych z powodu schizofrenii na oddziale dziennym.

Health related quality of life was evaluated in 40 schizophrenics from day hospital at admission, during the treatment and after 8 weeks. In contrast to the psychopathology which significantly decreased after 4 weeks already, the improvement of quality of life was found to be significant only at the discharge from day hospital. The quality of life did not correlate with the severity of schizophrenic symptoms. The older and more frequently hospitalized patients were, the less favorably they evaluated the quality of life. Patients professionally disabled were also less pleased with their quality of life. All quality of life domains improved after treatment with the exception of physical functioning and reported health transition. Physical functioning, role-physical, general health and mental health correlated inversely with severity of schizophrenia after treatment. There was no correlation between clinical improvement after treatment and quality of life domains. The higher was the patients' educational level the better they evaluated their vitality, social functioning and reported health transition.

[Comparison of quality of life of schizophrenic patients in different forms of psychiatric care]. / Porównanie oceny jakosci zycia chorych na schizofrenie objetych róznymi formami opieki psychiatrycznej.

Health related quality of life and severity of psychopathological symptoms were evaluated in 90 patients with schizophrenia, hospitalized in a psychiatric ward in a day hospital or followed by the therapist in a community care center. No statistical differences were found in the quality of life evaluation between patients from all three settings. The quality of life did not correlate with the severity of schizophrenic symptoms. Older patients and those more frequently hospitalized were more pessimistic in evaluation of their quality of life. Health status transition, as compared to the situation one year before, correlated inversely with patients' age. Male patients as well as patients from schizophrenic families evaluated their quality of life as worse.

[Follow-up studies of psychotic patients receiving inpatient treatment or alternative forms of psychiatric care]. / Badania katamnestyczne pacjentów psychotycznych leczonych w oddziale pelnodobowym lub w alternatywnych formach lecznictwa psychiatrycznego.

An analysis of populations treated in the III Department of Psychiatry indicates that 12 years since the transformation of the organizational model of care for patients from sub-regionalized catchment area, inpatient treatment continues to be of major importance, as it was provided to over half of all referrals. Intermediate forms of care, replacing a half of the former number of psychiatric beds, were offered mainly to schizophrenic patients, with the exclusion of those with a marked agitation, psychomotor retardation, or aggressive, presenting imminent danger to self or others. At one-year follow-up J.E. Overall's scale was used to examine 39 schizophrenic patients treated at the inpatient ward, day hospital, or by a community treatment team. Patients treated at the day hospital providing an intense therapeutic program manifested a significantly more marked improvement in respect of 6 symptoms: autism, affective bluntness, guilt feelings, tension, suspiciousness, and bizarre thoughts. No significant differences were found between the compared forms of care as regards the degree of other symptoms amelioration. Thus, the day hospital turned out to be a more effective form of care in case of schizophrenic patients manifesting the cluster of symptoms listed above.

[Family burden of patients receiving inpatient treatment or alternative forms of psychiatric care]. / Obciazenie rodzin pacjentów leczonych w oddziale pelnodobowym lub w alternatywnych formach lecznictwa psychiatrycznego.

Professionals working with chronic patients are usually aware of vast deficitis in what is called in the literature "natural support networks". The deficits generally increase over time, as is the case with broadly defined social skills. Although the efficacy of biological treatment was similar in all the three forms of care, nevertheless, patients and their families, when left without psychotherapeutic support provided to them by the day hospital or community treatment team, at one-year follow-up indicated lack of any satisfactory improvement in many dimensions of their functioning, and in some aspects-even a progressive deterioration.

[The evaluation of subjective quality of life in patients with schizophrenia or depression]. / Próba analizy subiektywnej oceny jakosci zycia pacjentów z rozpoznaniem schizofrenii lub depresji.

Subjective evaluation of the quality of life was studied in 53 schizophrenics (hospitalized, from the day-hospital, and from the rehabilitation unit) and in 12 depressed patients before and after pharmacological treatment or rehabilitation. The self-evaluation questionnaire SF-36 was used. The subjective quality of life of depressive patients at baseline was low in comparison to the schizophrenics. The best improvement of subjective quality of life after the treatment was found in hospitalized schizophrenic patients. Evaluation of the quality of life both before and after treatment/rehabilitation did not correlate with doctors' estimation of the severity of their illness. Depressive patients expressed more negative opinion regarding their physical condition and social activity than did the schizophrenics. The positive opinion on patients' health status correlated positively with good evaluation of patients' physical condition and good performance at home or work.